Clinicopathologic Diagnosis of Differentiated Vulvar Intraepithelial Neoplasia and Vulvar Aberrant Maturation
| Autor: | Tania Day, Ken Jaaback, James Scurry, Ross Pagano, Alexandra Marzol |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Rural Population
squamous cell carcinoma Pathology medicine.medical_specialty Acanthosis Lichen sclerosus differentiated VIN Vulva lichen sclerosus Risk Factors Atypia Humans Medicine Aged Aged 80 and over Vulvar Neoplasms HPV-independent lichen planus integumentary system business.industry Genes p16 Obstetrics and Gynecology General Medicine Genes p53 vulva medicine.disease Dyskeratosis vulvar aberrant maturation Lichen Sclerosus et Atrophicus medicine.anatomical_structure Pleomorphism (cytology) ComputingMethodologies_DOCUMENTANDTEXTPROCESSING Carcinoma Squamous Cell Female Vulvovaginal Neoplasia Vulvar Disorder New South Wales high-grade squamous intraepithelial lesion business Hyperchromasia Carcinoma in Situ |
| Zdroj: | Journal of Lower Genital Tract Disease |
| ISSN: | 1526-0976 |
| Popis: | Supplemental digital content is available in the text. Objective The aim of the study was to describe the demographic, clinical, and histopathologic features of differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar aberrant maturation (VAM). Methods Specimens from 2010 to 2020 reported as dVIN or VAM were reviewed. Clinical data included age, rurality, symptoms, and evidence of lichen sclerosus (LS). Histopathologic data included epithelial thickness, keratinization, architectural and dyskeratotic features, stroma, p16, and p53. Differentiated vulvar intraepithelial neoplasia and VAM were distinguished by assessment of basal nuclear chromatin, enlargement, pleomorphism, and mitoses. Results One hundred twenty women with a median age of 71 years had 179 examples of dVIN and VAM. Squamous cell carcinoma was concurrent in 66% and associated with rurality. Ten percent were asymptomatic, and all but 3 had evidence of LS. Differentiated vulvar intraepithelial neoplasia showed a range of thickness, architecture, and dyskeratosis; its unifying !feature was basal atypia. Differentiated vulvar intraepithelial neoplasia displayed hyperchromasia in 83% and easily observed mitoses in 70%. Nonkeratinizing morphology, subcategorized into basaloid and intermediate, occurred in 24% of women with dVIN. Traditional dVIN represented 62% of keratinizing cases; the remainder were atrophic (13%), hypertrophic (13%), acantholytic (8%), or subtle (5%). Vulvar aberrant maturation had abnormal stratum corneum, acanthosis, premature maturation, and enlarged vesicular nuclei. Null p53 helped distinguish dVIN from VAM and dermatoses. Conclusions The morphology of dVIN encompasses nonkeratinizing and keratinizing types, the latter subdivided into traditional, acantholytic, atrophic, hypertrophic, and subtle. Diagnosis relies on basal atypia with supportive p16 and p53. Atypia exists on a biologic spectrum with mild abnormalities of VAM and reactive change. Identification of dVIN and VAM requires collaboration between clinicians and pathologists experienced in vulvar disorders. |
| Databáze: | OpenAIRE |
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